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None of the writing, opinions, or information contained in this blog should be taken as any kind of suggestion for your own diabetes care. I am not a doctor, dietician or trained diabetes educator (although I play one in real life) and have no formal medical training. If you have questions or concerns about individual health matters or the management of your diabetes, please consult your doctor, specialist nurse or diabetes care team.

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Category: diabetes technology

Diabetes technology is changing quickly. Insulin pumps, continuous glucose monitors, flash monitors and new insulins are constantly changing. Diabetes Advocacy works to bring you the latest information on the products.

We highlight innovations and why choice is important for people living with diabetes. Diabetes Advocacy has extensive pages that show you insulin options, the insulin pumps and infusion sets currently available, as well as which glucose monitoring product may be best suited for your lifestyle.

Diabetes Advocacy also offers you the latest information on traveling with your device. We have everything you need to know to fly, hike, drive, or boat.

The media has been shouting for a while now about the new “artificial pancreas” on the market. This is driving me crazy. It is not an artificial pancreas. It is a new insulin pump. This new pump has some automated features but it does not completely replace a pancreas that is not producing insulin. It does not bolus for food on its own. It is not a cure. What this new device is is a new device! It is another tool to help people living with diabetes live a better life. That is it!

Medtronic® does not call their latest insulin pump an artificial pancreas. They simply refer to it as “The world’s first self-adjusting insulin pump system for people with type 1 diabetes” (over 7 years of age). That is fair.

In auto-mode, this new pump will make adjustments and suspend itself. It uses information from the continuous glucose monitor (CGM) to predict rises and falls in blood glucose levels. The 670G (this self-adjusting insulin pump) will get your background insulin (your basal rate) under control for you. In turn, “the sensor must be calibrated at a minimum of every 12 hours throughout the life of the sensor. For better sensor performance, it is recommended that you calibrate your sensor three or four times each day.” (page 216 of users manual). The manual also notes that “the Auto Mode feature still requires your input for meals, calibrations, and times when you need the target value raised.” (page 231). Again, making this is not a true “artificial pancreas” but a new tool for people with insulin-dependent diabetes.

Choice is vital because everyone’s diabetes is different. Children have different needs from teens. Teens have different needs from adults. One adult requires different things from an insulin pump than another does. The good news though is that more choice is coming…or in some countries it is already here.

In the US, besides the Medtronic® 670G, you have the option to use the t:slim X2™ with Basal IQ™ (this option is available in countries where the t:slim X2™ is sold and the Dexcom® G6 is approved for use). This pump also has a great automated feature.

It predicts low blood glucose levels ahead of time and stops insulin delivery. The Basal IQ™ technology will allow the insulin pump to turn insulin delivery on and off as often as every 5 minutes. As I noted, this system works with the Dexcom® G6 Continuous Glucose Monitor which is currently the only CGM approved for use without the need for fingerstick calibration.

These systems have been approved for use in the US and other countries. There are other projects that are still being tested like the iLet® project out of the University of Boston. Bigfoot Biomedical® is working on some exciting projects and patients are creating their own closed loop in the #WeAreNotWaiting projects.

The world of diabetes management tools is once again expanding at a fascinating rate. It is an exciting time.

We are not however at a time when diabetes is cured with an artificial pancreas. No system counts carbs—although the ILet potentially will allow the pump to learn how. Every system requires you to change out infusion sets that can kink or come out of the body. All of these systems require learning on the part of the user and the machine.

Perhaps in another 20 years, we will see a true artificial pancreas. Maybe in another 30 years, it will be available to everyone who needs one. In the meantime, people with diabetes must continue to educate themselves on the various features of insulin pumps and choose the pump that best fits their lifestyle.

Tandem® t:slim X2™ insulin pump has been approved for sale in Canada and I am excited. I know that this pump is not for everyone but for us…well, we have been waiting since it was first brought to the US market.

We were Cozmo users. Actually Cozmo lovers. Any pump after our beloved Cozmo was just not the same. So many features were missing. It felt like we were going back in time.

When the Tandem® t:slim™ insulin pump came out in the US, I was jealous. Many of our fellow Cozmo pumpers made the switch and were in love. It wasn’t perfect. Some people have issues with certain features but overall most of them felt that one or two annoyances (some of which the company is working to change) were more than worth it.

Let’s face it, this pump looks cool. It has an iPhone phone look. It also has some features that we have been missing and others that we are excited to see.

Here are a few of the features that the Tandem® t:slim X2™ have to offer Canadian insulin pumpers.

t:slim X2™ Features:

the smallest insulin pump currently available

has a 300 unit reservoir

does not use batteries but rather is recharged when you plug a USB cable into a regular AC current. You can go approximately 7 days between charges.

has a shatterproof, touchscreen

Dexcom integrated

Bolus by gram of carbs or units of insulin

Quick bolus option

Integrated calculator with numeric keypad

6 personalized delivery profiles

16 timed insulin delivery settings

Site change reminders

High and low blood glucose alerts

Missed meal bolus alerts

Remotely update software (no need to buy an entirely new pump!)

Waterproof for up to 3m for 30 minutes

For us, these are features that are worth getting excited about! You can read the full Tandem announcement here. You can also sign up to learn when the new Tandem® t:slim X2™ will be available in your province here.

Now that we have shown you why we love this new pump, I am curious, what features are most important for you when choosing an insulin pump? If you aren’t sure, download our ebooklet. It has a list of features that may or may not be important to you as well as questions to ask pump reps when you meet!

Whenever we have changed a site or try out a sensor, I have looked down at the pile of trash and feel incredible guilt. There seems to be so much “stuff” that we are putting in the garbage can. It can’t possibly be good for the environment. In an attempt to protect the world for my future grandchildren, I searched for some way to reduce our waste. Here is what I found.

Buy in bulk

If you are purchasing those travel sized packages of glucose tablets, you may want to consider buying the larger bottles. You can also go to your local Bulk Barn or Walmart and purchase low blood sugar treats in bulk. If you do this right after Halloween, you can usually score even more treats at a way lower price!

Once you get your glucose tablets or other low treats home, you can then break them down into properly portioned, travel sizes in reusable containers. Those old glucose tablet bottles can be great for this.

Recycle the cardboard

Test strips come in boxes. Insulin comes in boxes. Infusion sets come in boxes. You get the idea. There are a lot of boxes when you live with diabetes. The great news is that most boxes and paper inserts are recyclable. Simply break them down and place them in your cardboard recycling container.

Drop off electronic diabetes devices for recycling

Did you know that often your old glucometer and DexCom can be returned to a recycling depot? I didn’t! You no longer have to have a dead meter collection in your drawer because you worried about throwing them in the trash. Most will be accepted by your local e-waste or e-cycling drop-off center. If you aren’t sure of a location in your area, you can also go to Earth911.com for the nearest recycling location.

Reuse tubing and other “waste” materials

If you are using an insulin pump, you already have come up with some great ways to reuse your tubing. Young children love it when you snip the ends off of infusion set tubing and then let them string beads. They can spend hours making cute bracelets and more!

If you don’t have littles around, don’t worry, for those of you who like to garden, tubing is perfect for holding up plants!

Test strip bottle and insulin vials have many uses in creative art projects. Test strip bottles can also be perfect storage containers for thumb-tacks and other small items. Think about all of those things that you used to store in film containers and now you can put them in test strip bottles!

Recycle

After a bit of investigating, I did find that some diabetes supplies can be put in your household recycling bins.

Syringe caps can be recycled in areas that recycle bottle caps. The tops of the built-in inserters on inset®, insetII®s, mio®, Mio30®, Autosoft90® and Autosoft30® can also be recycled. Please ensure proper disposal of the insertion needles, however. If you use an OmniPod, you can take part in the Eco-pod program. It allows you to return pods to Diabetes Express for recycling.

If you are like me, you may still feel like there is a lot of waste in diabetes care but I was surprised to read a study that showed that there may not be as much as we think. A person consuming one soft drink or one beer in a can only every three days has a similar impact on the environment as eleven insulin pump patients using one infusion set each in the same time period. Let me repeat that….one beverage can every three days creates the same amount of waste as eleven pumpers who use one infusion set each!

A person using a tubed insulin pump in fact only produces the same amount of environmental waste as a person who purchases one cup of coffee per day. Mind-blowing.

As great as that makes me feel, by using the tips above, we can further reduce the environmental impact of diabetes waste.

In May of 2012, after reading about a friend having problems getting their insulin pump through security at a US airport, I did some research on the subject. Should you put your pump through the x-ray machine? Can you wear your CGM through a full-body scanner? There were a lot of questions in 2012 and there still are in 2018 so I reached out to a few friends in the industry to see if things have changed at all. Here is what you need to know when you are traveling with an insulin pump or CGM.

If you wear a Dexcom®

The Dexcom® G5 is cleared to take through metal detectors, be hand-wanded and be worn during flights. There are a few situations to be concerned about, however.

NEVER put your receiver or extra sensors through an x-ray machine. Ask the security personnel to do a hand-check of the items to avoid permanent damage of these devices.

According to Dexcom®, the effects of full body scanners on CGM components have not been studied. It is therefore recommended that you do not take your Dexcom® through one.

Once you are through security and on your plane waiting for takeoff, make sure to set your app to airplane mode, keeping the bluetooth on and leave your receiver turned on.

If you use FreeStyle Libre

The Dream Big Travel Far blog contacted the people at FreeStyle and asked what the guidelines were for air travel with the Libre. This is what they reported.

“We recommend the user notify security personnel when going through airport security screening. the user can go through X-ray machines while wearing a sensor. We recommend the reader be powered off during a flight and not used for scanning a sensor. However, the strip port on the reader can be used to take blood glucose or ketone readings during flight. Turning on the reader with the Home Button will activate the radio. The user must turn on the reader by inserting a test strip so as to not activate the radio.”

If you wear an Omnipod

Good news for Omnipod users! You can wear the pod through the metal detector, x-ray machines and full body scanners with no worry. The PDM can also go through the X-ray. Insulet does recommend that if you are selected for a “pat down” you disclose that you are wearing the pod.

If you wear a Medtronic® insulin pump

Medtronic® insulin pumps can be worn through metal detectors and be wanded. They should NOT be sent through x-ray machines however.

Medtronic® also notes that your sensor and transmitter must be removed if you are going through a full-body scanner. If you do not want to remove your sensor, you can ask to be pat down instead.

If you wear a Tandem® t:slim X2™ insulin pump

Tandem® t:slim X2™ can be worn through metal detectors and can be wanded. They should not be sent through x-ray machines.

Changes in air pressure cause bubbles to form in insulin, and the related expansion can cause unintentional insulin delivery. This is NOT a problem in the Tandem pump.

The pumping mechanism used in Tandem pumps isolates the insulin reservoir (bag) from the user line, so if bubbles are formed in the cartridge due to pressure changes, the internal bag will expand, but no insulin will be delivered to the user from the reservoir. The only volume in line with the user at any given time is the insulin in their infusion set and cartridge tubing, and the contents of the 0.3 unit Micro-Delivery chamber.

There is no need to turn off your t:slim X2™ during takeoff or landing. This system runs on Bluetooth which can operate during flights. If you are also using a Dexcom CGM that you are viewing with your smartphone, turn the phone on airplane mode and then turn on Bluetooth.

Johnson and Johnson announced on September 5th of 2017 that they were closing the doors on their insulin pump division in Canada and the US. Animas Insulin Pumps would be no more. Animas insulin pumpers in North America were heartbroken.

While some saw it coming in the corporate rumour mill, others were blindsided.

Animas had done something that many companies in many industries are striving to do…they had created a feeling that you were family. Whether you were an Animas insulin pumper or you used another brand, you had probably attended an Animas event and were treated royally.

The employees with Animas all seemed to genuinely care about you. They checked in on you and took the time to know your family. I had the pleasure to work closely with many members of the Animas family over the years. They will be huge assets for the next company that employs them. I am sure that many of them are just as saddened as we are.

This is not the first time that an insulin pump company has closed its doors. We have been here before…twice.

Cozmo (personally a pump like no other) closed its doors in 2009. We still have two in my son’s closet. I have friends who still wear this as their pump of choice. It is doable even 8 years later.

Most recently, Asante, a pump revered by many who tried it, was also forced to step away from the insulin pump market. Their users were devastated. They were heartbroken and felt lost–just like Animas insulin pumpers are feeling today.

How did they go forward?

One step at a time. The great thing about insulin pumps is that, while some have quirks, many are pretty sturdy and last. If you have more than one pump in your house–usually because one was out of warranty and you purchased a new one right away “just in case”, relax. If for some reason, you current pump stops functioning, go back on your old one while you decide which pump to try next! Just make sure to write down those settings and keep them in a safe place.

What do I do now?

You don’t have to stockpile supplies You don’t have to run out and buy a new insulin pump tomorrow. The Animas press release stated that warranties will continue to be honoured until September 2019. Cartridges will be be available until that date as well.

Statements from both Animas and Medtronic note that supplies will still be able to be ordered in the same way as before. Nothing changes, except when your Animas pump stops working, you will not be able to purchase a new one.

Thank you…

So while we take a breath and rethink our next steps…our next pump…our next option, I want to take a moment and say thank you. Thank you to the men and women who worked so hard to make Animas a different company. I truly appreciated getting to know so many of you. You brought us a new experience in caring. I hope that we meet again soon, with a new company perhaps bringing new options in diabetes care.

Options are the most important thing. Make sure to always know your options and always choose the option that works best for you and your lifestyle.

When my son was with us over Christmas, we were able to try out a DexCom. As mom, it was AMAZING!! I was completely in love. Despite a bit of warm up time, it quickly gave us a great overview of how his bg levels were trending.

We instantly knew if we had bolused properly for that Chinese buffet. We knew if that site change had actually worked. It was heavenly. At night, I would wake up, peek at the graph and know right away if I needed to get up or if I could roll over and sleep for a bit longer. I had peace of mind that I had not felt in years. It was a true gift.

My son was less impressed. To him it was another device to wear. It was another thing to carry around. It was another piece of equipment to have attached to his body. He was not sold on it. It was simply okay but not something that he could see himself really wanting any time soon.

I was sad but my wallet was okay with the decision. Perhaps when he was in the workforce, he would see the benefit. At that point, technology would probably make it smaller and more accurate. At this point in his life, it is completely his choice.

My son was recently back visiting with us again. We have no DexCom. His visit was too short to warrant trying out the new Vibe or even having him try a DexCom again. On the first night that he arrived I asked him if he still wanted me to test him at night while he was here? His answer was a very quick “I’m on holidays. Of course I want you to test me! My meter will be right here for you.”

I was glad to be able to give him a bit of a break and some peace of mind in knowing that he didn’t have to do it all himself.

The first night he was high. A few bad decisions and a bad site combined to equal terrible readings. As I lay in bed I wondered, should I test him now? Should I retest him? We were at the cabin and he was sharing a room with his brother. I would most likely wake up my oldest son who had to be at work early in the morning if I went in often. When was the best time to check things out? I struggled. I tossed. I slept in short bursts.

The second night was not much better. He tested before we both went to bed. His reading was perfect. He was worried that he was too low for sleep. We discussed his meal choices for the day and I reassured him that he would be fine. To alleviate his fears, he had some chocolate milk before he went to sleep and only partially covered it with insulin. Chocolate milk has been our “go to” for awhile. It has just enough sugar to boost him and just enough fat to keep things even for a longer period of time.

I woke up a few times wondering if I should test him. Was I right? Were things going perfectly? A trending graph would have been so helpful. Finally I got up at the time that I had set in my mind to check on him. He was perfect. 6.1 (110) Now I was nervous. Perfect could go either way very quickly. Was he safe? Would he drop? I wasn’t overly concerned about a spike but would he drop?

I went back to bed reminding myself of the DexCom graph the last night he was here. His nights were great. He was virtually a flat line for most of the time once he left. We had made a few small tweaks but nights should be okay. I should have been able to sleep. I tossed and wondered. Three hours later, I had to check. Which way had he gone?

He was now 7 (126). All was perfect. He was fine. He had made it through the night. His basals looked perfect. I could rest and sleep…well except for the fact that the sun was shining and I had to be up for an appointment.

”Artificial Pancreas approved by FDA” Sounds great doesn’t it? Its sadly right up there with “Scientists find way to cure diabetes”…in mice. Well, its not quite that bad but it is media hype that does not quite match the reality of the innovation.

TheMedtronic Veo insulin pump has been available in Canada for quite some time. For a change, we were able to avail of a new technology before the US market. In this case, it means availing of a technology that shuts down your insulin pump if your CGM tells the pump that you are low and dropping. This is a pretty great feature but does not for many equate to a true “artificial pancreas”.

A number of people in the diabetes community feel that a true artificial pancreas is more in keeping with Dr. Ed Damiano’sBionic Pancreas project rather than these smarter pumps. His pro-type has been used on adults and children with Type 1 diabetes in real world settings. A bulky model at that moment, but it has given people with Type 1 diabetes a freedom that they have not experienced since prior to their diagnosis.

Dr. Damiano’s approach combines the use of insulin, glucagon, a CGM, a smart insulin pump, and finally an iPhone. With all of this, he is able to create a pancreas for people like his son who live with Type 1. Those who have listened to his presentation (like myself) walk away amazed and inspired. Those who haveused the systemtalk of an experience like nothing that they have ever imagined before. They were able to enjoy meals without carb counting. They had nights without testing. They experienced relatively stable bg levels. It is truly amazing.

This research is not funded by an insulin pump company. This researched is fueled by a father’s desire to keep his son safe. David Damiano was diagnosed with Type 1 diabetes at the age of 11 months. This amazing project has given my own son hope where he didn’t have a lot before.

There are many great changes in the wind for people living with diabetes. Whether we are looking at a bionic pancreas, an artificial pancreas, or simply the improved accuracy of Continuous Glucose Monitoring systems. Diabetes care has moved forward a lot since our journey began over 13 years ago. I am excited to see it move forward much further in the next 13! The next challenge will be to ensure that people living with diabetes will have the ability to access these improved technologies.

It was recently that time of year again…time to clean out our diabetes supplies. What once was able to fit in a drawer was now taking up a drawer, a roll-out tote, and underneath of my youngest son’s bed. This had to stop. I had no clue that he had supplies hidden in all of these places and was no longer sure as to what supplies we had and what we needed.

We found boxes of Cozmo reservoirs, a few different types of infusion sets, his very first meter, a Polar bear meter holder, way too many lancing devices and enough lancets to keep him going until he is 100. We also found test strips that were about to expire. There was no way I was going to waste these strips. This was $100 and many people can’t even afford to buy them. The strips would be used at home until such time as they were gone.

My son was fine with that. Like his mother, he loves trying out new meters. This meter was far from new but since he hadn’t used it in a few years, it was new to him again. The novelty quickly wore off.

“Mom, this meter takes FOREVER to read!”

“How long is forever?”

“15 seconds! Can you believe that? This is crazy!”

I started to laugh! My son was far to used to the immediate gratification found after a five second countdown. He did not remember the days of his first meter. Thirty seconds seemed like an eternity and yet I remember back then knowing how lucky we were, the previous generation of meters had taken 60 seconds to show results.

Despite the “long” wait, he continued to use the old strips. A few lows and bad sites meant that it did not take more than a few weekends for the 100 test strips to be used up. I must admit that I had been spoiled too. A few nights of having to wait for those extra 10 seconds did seem like forever. Nonetheless, it still was not as long as waiting 30 seconds and wondering if your toddler was asleep because he was tired or passed out from a low.